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Biomarker testing in MCI patients—deciding who to test

van Maurik, Ingrid S. ; Rhodius-Meester, Hanneke F.M. ; Teunissen, Charlotte E. ; Scheltens, Philip ; Barkhof, Frederik ; Palmqvist, Sebastian LU orcid ; Hansson, Oskar LU orcid ; van der Flier, Wiesje M. and Berkhof, Johannes (2021) In Alzheimer's Research and Therapy 13(1).
Abstract

Background: We aimed to derive an algorithm to define the optimal proportion of patients with mild cognitive impairment (MCI) in whom cerebrospinal fluid (CSF) testing is of added prognostic value. Methods: MCI patients were selected from the Amsterdam Dementia Cohort (n = 402). Three-year progression probabilities to dementia were predicted using previously published models with and without CSF data (amyloid-beta1-42 (Abeta), phosphorylated tau (p-tau)). We incrementally augmented the proportion of patients undergoing CSF, starting with the 10% patients with prognostic probabilities based on clinical data around the median (percentile 45–55), until all patients received CSF. The optimal proportion was defined as the proportion where... (More)

Background: We aimed to derive an algorithm to define the optimal proportion of patients with mild cognitive impairment (MCI) in whom cerebrospinal fluid (CSF) testing is of added prognostic value. Methods: MCI patients were selected from the Amsterdam Dementia Cohort (n = 402). Three-year progression probabilities to dementia were predicted using previously published models with and without CSF data (amyloid-beta1-42 (Abeta), phosphorylated tau (p-tau)). We incrementally augmented the proportion of patients undergoing CSF, starting with the 10% patients with prognostic probabilities based on clinical data around the median (percentile 45–55), until all patients received CSF. The optimal proportion was defined as the proportion where the stepwise algorithm showed similar prognostic discrimination (Harrell’s C) and accuracy (three-year Brier scores) compared to CSF testing of all patients. We used the BioFINDER study (n = 221) for validation. Results: The optimal proportion of MCI patients to receive CSF testing selected by the stepwise approach was 50%. CSF testing in only this proportion improved the performance of the model with clinical data only from Harrell’s C = 0.60, Brier = 0.198 (Harrell’s C = 0.61, Brier = 0.197 if the information on magnetic resonance imaging was available) to Harrell’s C = 0.67 and Brier = 0.190, and performed similarly to a model in which all patients received CSF testing. Applying the stepwise approach in the BioFINDER study would again select half of the MCI patients and yielded robust results with respect to prognostic performance. Interpretation: CSF biomarker testing adds prognostic value in half of the MCI patients. As such, we achieve a CSF saving recommendation while simultaneously retaining optimal prognostic accuracy.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Biomarkers, Decision support, MCI
in
Alzheimer's Research and Therapy
volume
13
issue
1
article number
14
publisher
BioMed Central (BMC)
external identifiers
  • pmid:33413634
  • scopus:85098846945
ISSN
1758-9193
DOI
10.1186/s13195-020-00763-7
language
English
LU publication?
yes
id
40cb553f-cb73-4fb1-aec2-7f6f1e6f7c75
date added to LUP
2021-01-12 11:29:36
date last changed
2025-01-11 02:24:51
@article{40cb553f-cb73-4fb1-aec2-7f6f1e6f7c75,
  abstract     = {{<p>Background: We aimed to derive an algorithm to define the optimal proportion of patients with mild cognitive impairment (MCI) in whom cerebrospinal fluid (CSF) testing is of added prognostic value. Methods: MCI patients were selected from the Amsterdam Dementia Cohort (n = 402). Three-year progression probabilities to dementia were predicted using previously published models with and without CSF data (amyloid-beta1-42 (Abeta), phosphorylated tau (p-tau)). We incrementally augmented the proportion of patients undergoing CSF, starting with the 10% patients with prognostic probabilities based on clinical data around the median (percentile 45–55), until all patients received CSF. The optimal proportion was defined as the proportion where the stepwise algorithm showed similar prognostic discrimination (Harrell’s C) and accuracy (three-year Brier scores) compared to CSF testing of all patients. We used the BioFINDER study (n = 221) for validation. Results: The optimal proportion of MCI patients to receive CSF testing selected by the stepwise approach was 50%. CSF testing in only this proportion improved the performance of the model with clinical data only from Harrell’s C = 0.60, Brier = 0.198 (Harrell’s C = 0.61, Brier = 0.197 if the information on magnetic resonance imaging was available) to Harrell’s C = 0.67 and Brier = 0.190, and performed similarly to a model in which all patients received CSF testing. Applying the stepwise approach in the BioFINDER study would again select half of the MCI patients and yielded robust results with respect to prognostic performance. Interpretation: CSF biomarker testing adds prognostic value in half of the MCI patients. As such, we achieve a CSF saving recommendation while simultaneously retaining optimal prognostic accuracy.</p>}},
  author       = {{van Maurik, Ingrid S. and Rhodius-Meester, Hanneke F.M. and Teunissen, Charlotte E. and Scheltens, Philip and Barkhof, Frederik and Palmqvist, Sebastian and Hansson, Oskar and van der Flier, Wiesje M. and Berkhof, Johannes}},
  issn         = {{1758-9193}},
  keywords     = {{Biomarkers; Decision support; MCI}},
  language     = {{eng}},
  number       = {{1}},
  publisher    = {{BioMed Central (BMC)}},
  series       = {{Alzheimer's Research and Therapy}},
  title        = {{Biomarker testing in MCI patients—deciding who to test}},
  url          = {{http://dx.doi.org/10.1186/s13195-020-00763-7}},
  doi          = {{10.1186/s13195-020-00763-7}},
  volume       = {{13}},
  year         = {{2021}},
}